Osteotomy About the Knee – Applications, Techniques, and Results

Abstract

Varus or valgus malalignment of the knee may be either a cause or a consequence of unicompartmental knee arthritis in young, active adults. Proximal tibial osteotomy for the varus knee and distal femoral osteotomy for the valgus knee have been used for decades to manage this condition; however, their use has decreased signifi cantly in recent years as the popularity of unicompartmental and total knee arthroplasty has grown. With the advent of biologic resurfacing techniques for focal full-thickness articular cartilage injury, combined or staged high tibial osteotomy is becoming increasingly popular. In addition, in the face of cruciate ligamentous instability with or without posterolateral corner instability coupled with varus malalignment, high tibial osteotomy with and without ligament reconstruction provides a solution to complex orthopedic problems. Recent long-term follow-up studies have concluded osteotomy allows for improved function and pain relief in properly selected young patients. [J Knee Surg. 2005;18:258-272.]

Distal femoral osteotomy

“…The correct selection of the patients undergoing DFO, as well as HTO, is mandatory for achieving good outcomes [16]. DFO can be performed to correct both congenital malalignment and posttraumatic deformity [17, 18••].…”

“…Obesity, evaluated as 1.32 times the normal weight or BMI greater than 30 kg/m 2 , has been associated with poorer outcomes [2••, 19]. Presence of inflammatory disorders should be addressed as well; in this population, valgus deformity is common, but osteotomies are normally contraindicated [16]. Patients considered for a DFO should be less than 65 years old, active, and affected only by lateral arthritis; however, not only the age, but also the activity level, lifestyle, and general health must be taken into consideration [18••].…”

Mosaic Сhondroplasty of Full-Thickness Defects of Knee Articular Surfaces in its Destructive Dystrophic Lesions

“…Указанные мероприятия, в частности корригирующую остеотомию, можно планировать и отдельным этапом, но, с нашей точки зрения, было бы целесообразным выпол-нять их одновременно. Однако можно прогно-зировать определенные трудности в развитии данного направления, так как в настоящее время отсутствует интеграция между этими двумя несомненно эффективными методами лечения поражений хряща коленного сустава [14,15]. Достоверно лучшие результаты приме-нения предложенного способа хондропластики с использованием костных губчатых аутотран-сплантатов, наблюдавшиеся в раннем и позднем послеоперационном периодах, мы связываем со снижением интраоперационной травмы тканей сустава, возможностью получения необходимо-го объема пластического материала и его значи-тельно большими возможностями к интеграции с окружающими тканями и морфологической перестройке по сравнению с потенциально не-полноценной хрящевой тканью в случае забора трансплантатов в этом же суставе.…”

Corrective Tibial Osteotomy in Young Adults Using an Intramedullary Nail

“…Therefore, the level of osteotomy for our novel technique was below the tibial tuberosity. This level has several advantages27,28) including greater degree of correction and preservation of the proximal tibial anatomy28). The large proximal fragment decreases the chances of avascular necrosis and iatrogenic tibial plateau fracture which can occur in a conventional medial opening wedge osteotomy28).…”